Prevention in Practice

The Sugar War

The sugar war is heating up, with skirmishes on a number of fronts, including the City of New York, the state government in Mississippi, and the Food and Drug Administration (FDA) in Washington. It’s a guerilla war between the public health community and Big Food, pitting science and public education against the best lawyers, lobbyists, public relations firms, and marketing experts that really big money can buy.

In February, a coalition of scientists and health advocates, led by the Center for Science in the Public Interest (CSPI), petitioned the FDA to both set safe limits for sugar consumption and to acknowledge that added sugars should be declared unsafe at the levels at which they’re typically consumed. CSPI’s regulatory petition details substantial scientific evidence that added sugars, especially in drinks, cause weight gain, obesity, and chronic diseases like diabetes, heart disease, and gout. An April 2013 article in AJPM says that sugar-sweetened beverages are primarily responsible for higher caloric intakes of children who consume them.

Most recently, a state trial judge struck down New York City’s proposed limits on large sugary drinks, one day before they were to take effect. And on the same day, senators in Mississippi have approved, by a supersized majority, a bill that would prevent similar efforts to those in New York City in their state. The New York City plan, unveiled last May, was hailed by many public health officials as a breakthrough in the effort to combat the effects of high-calorie, sugary drinks on the public’s health. Not surprisingly, Mayor Bloomberg’s proposal was met with fierce opposition by the beverage industry.

The soft drink industry had viewed the fate of the proposed rules in New York as a global bellwether on government regulation of sugary drinks. That’s a reach. It’s only a battle, not the war. The Bloomberg administration said it would appeal the decision. And the fight over soda regulation is likely to intensify beyond New York in the coming months.

What’s at stake? Money and the health of the public The money is enormous, including food industry profits, healthcare costs, and national productivity. At the current rate, almost half of all Americans are expected to be obese by 2030, and stemming that increase could result in at least $550 billion in healthcare savings over the next 20 years. Big Food earnings are estimated to be in the trillions.

The rhetoric has gotten blunt: “I’ve got to defend my children, and yours, and do what’s right to save lives,” New York City Mayor Bloomfield said. “Obesity kills. There’s no question it kills.” “People are dying every day. This is not a joke. This is about real lives.”

There is science to support him, but phrased a little differently. Epidemiologist Dr. Robert Lustig simply says that sugar is toxic. Lustig’s 2009 YouTube video lecture Sugar: The Bitter Truth has received over 3 million hits, and his book Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity and Diseasearrived in bookstores in December 2012.

He is a co-author of a just-published PLoS One study on the relationship of sugar to population-level diabetes prevalence. The researchers find that differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight, or obesity. Science fact, not science fiction—but still small arms against the arsenal of Big Food.

Lustig’s been in the trenches a long time. He takes issue with the landmark Seven Countries study begun in the 1950s that linked dietary fat to cardiovascular disease. Lustig argues that the study is flawed because it discounted sucrose intake associated with the fats in the American diet, and the sugar introduced into the diets of study participants in the other countries who took on a more American diet, without testing to see if the sugar itself had any bearing on the study’s findings. He contends that the excessive consumption of energy via those sugars leads to greater health impairments than the fats that were the focus of study.

In the process of dispensing “low-fat” dietary directives, an unstated implication is that replacement of fat with carbohydrate is a rational approach. Healthcare providers must recognize the differences between glucose and fructose and that despite fructose’s classification as a carbohydrate, it is metabolized more like fat. It is this author’s opinion that a low-fat diet in America is tantamount to a high-fat diet, as increased fructose ingestion because of substitution of fructose for fat to improve palatability causes the same metabolic perturbations as does a high-fat diet.

Journalist and author Gary Taubes (Why We Get Fat; Good Calories, Bad Calories) is another foot soldier. In his 2011 New York Times article “Is Sugar Toxic,” he explains that Lustig’s argument is not about the consumption of empty calories but rather that sugar has unique characteristics, specifically in the way the human body metabolizes the fructose in it, which may make it singularly harmful.

Taubes also brings fresh ammunition in the form of a nonprofit that he has co-founded, the Nutrition Science Initiative (NuSI). The mission: “reducing the economic and social cost of obesity and its related chronic diseases. We hope to achieve this by facilitating and funding the kind of rigorous, meticulously well-controlled and targeted experimental research that has been conspicuously lacking in nutrition research for the half past century.”

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